Some thoughts on health and healthcare

Abstract Secondary use of healthcare data for research, population health management, quality improvement, policy, and artificial intelligence cannot be implemented successfully as a purely technical data-platform initiative. Its reliability depends on the quality, provenance, semantic consistency, and clinical relevance of data generated during care. The central argument of this essay is that healthcare organizations should implement secondary data use through a “primary-use first” strategy: data must first help clinicians, nurses, patients, and multidisciplinary teams make better decisions in real care pathways. Only then can the same data become a trustworthy foundation for research, management, innovation, and AI. This requires clinical governance, workflow redesign, semantic standardization, continuous data-quality measurement, trustworthy access governance, and feedback loops that return value to care delivery. The learning health system provides the most appropriate conceptual ...

Abstract Introducing Artificial Intelligence (AI), Large Language Models (LLMs), and Robotic Process Automation (RPA) in a Belgian hospital should not be treated primarily as an IT procurement exercise. It is a clinical, legal, organizational, and ethical transformation. AI can support diagnosis, triage, logistics, population health, and administrative optimization; LLMs can assist with documentation, translation, summarization, coding, and knowledge retrieval; and RPA can automate repetitive digital workflows such as data entry, report routing, claims preparation, and system monitoring. In Belgium, however, implementation must be aligned with the General Data Protection Regulation (GDPR), the EU Artificial Intelligence Act, the European Health Data Space (EHDS) Regulation, Belgian health-data governance structures, and the hospital’s duty to preserve clinical safety, security and patient trust. The safest introduction model is therefore phased: establish governance, select low-risk hi...

Introduction In Belgium, hospital financing reform should start from the target state to be achieved rather than from the inherited institutional configuration to be incrementally adjusted. That is especially important because the Belgian health system is structurally path-dependent: it combines near-universal compulsory insurance with direct access, predominantly fee-for-service remuneration, and a division of responsibilities between the federal state and the federated entities that was deepened by the sixth State reform. In hospital financing, Belgium already uses All Patient Refined Diagnosis Related Groups (APR-DRG)/Severity of Illness (SOI) information for budget allocation, but not as a true case-based payment system with national cost weights; the current B2 logic of the Budget of Financial Means (BFM) uses national average length of stay by APR-DRG/SOI as a proxy for resource use. At the same time, Belgium has two mandatory hospital datasets with major strategic value: Minima...